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Welcome to the nexus of ethics, psychology, morality, philosophy and health care

Friday, October 13, 2017

Moral Distress: A Call to Action

The EditorAMA Journal of Ethics. June 2017, Volume 19, Number 6: 533-536.

During medical school, I was exposed for the first time to ethical considerations that stemmed from my new role in the direct provision of patient care. Ethical obligations were now both personal and professional, and I had to navigate conflicts between my own values and those of patients, their families, and other members of the health care team. However, I felt paralyzed by factors such as my relative lack of medical experience, low position in the hospital hierarchy, and concerns about evaluation. I experienced a profound and new feeling of futility and exhaustion, one that my peers also often described.

I have since realized that this experience was likely “moral distress,” a phenomenon originally described by Andrew Jameton in 1984. For this issue, the following definition, adapted from Jameton, will be used: moral distress occurs when a clinician makes a moral judgment about a case in which he or she is involved and an external constraint makes it difficult or impossible to act on that judgment, resulting in “painful feelings and/or psychological disequilibrium”. Moral distress has subsequently been shown to be associated with burnout, which includes poor coping mechanisms such as moral disengagement, blunting, denial, and interpersonal conflict.

Moral distress as originally conceived by Jameton pertained to nurses and has been extensively studied in the nursing literature. However, until a few years ago, the literature has been silent on the moral distress of medical students and physicians.